Metropolitan Jewish Health System Hospice and Palliative Care (“MJHS Hospice”), a New York nonprofit hospice provider, has agreed to pay the United States $4,850,000 to resolve civil allegations that it billed Medicare and Medicaid for services rendered to hospice patients at heightened levels of care for which the patients did not qualify, in violation of the False Claims Act, and has agreed to pay the State of New York $375,000.
Seth D. DuCharme, Acting United States Attorney for the Eastern District of New York, announced the settlement. Mr. DuCharme thanked the Office of the Inspector General of the U.S. Department of Health and Human Services and the New York State Attorney General for their assistance in the investigation.
The settlement resolves allegations that MJHS Hospice knowingly billed Medicare and Medicaid for unnecessary levels of hospice care to patients. Medicare’s and Medicaid’s hospice benefits are available for patients who elect palliative treatment (medical care focused on the patient’s relief from pain and stress) for a terminal illness.
Under the Medicare and Medicaid programs, a hospice provider may seek payment for several levels of care, including heightened levels known as “CHC” (continuous home care services) and “GIP” (general inpatient services). To receive reimbursement for CHC, a hospice provider must show that a patient is experiencing acute medical symptoms. For a hospice provider to obtain reimbursement for GIP, a patient must need pain control, or acute or chronic symptom management, which must be managed in a hospital. After an extensive investigation, the United States determined that from 2011-2015, MJHS falsely claimed that some of its patients required CHC and, in 2012, falsely claimed that some patients required GIP.
“It is vital that the terminally ill have appropriate access to hospice care, including levels of care that are available under Medicare and Medicaid. This Office recognizes the importance of preserving limited federal health care funds for this purpose, and to holding health care providers accountable when they seek reimbursement for care that is not reasonable and necessary,” stated Acting United States Attorney DuCharme.
The allegations were brought to the government’s attention through the filing of a complaint pursuant to the qui tam provisions of the False Claims Act. Under the Act, private citizens can bring suit on behalf of the United States and share in any recovery. The claims resolved by the settlement are allegations only and there has been no finding of liability by a court.
The United States’ case was handled by Assistant U.S. Attorney Lisa D. Kutlin of the Office’s Civil Division, with assistance from Affirmative Civil Enforcement Auditor Michael Gambrell.
E.D.N.Y. Docket No. 14-CV-4201 (FB)